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COST-EFFECTIVENESS AND CLINICAL IMPLICATIONS OF ADVANCED BEARINGS IN TOTAL KNEE ARTHROPLASTY: A LONG-TERM MODELING ANALYSIS

Published online by Cambridge University Press:  28 April 2014

Peter Fennema ,
Thomas J. Heyse  and
Carin A. Uyl-de Groot
Peter Fennema
Affiliation:
Netherlands Institute for Health Sciences, and AMR Advanced Medical Research
Thomas J. Heyse
Affiliation:
Department of Orthopedics and Rheumatology, University Hospital Marburg
Carin A. Uyl-de Groot
Affiliation:
Institute for Medical Technology Assessment, Erasmus University
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Abstract

Background: Polyethylene (PE) wear is a major contributor to implant loosening following total knee arthroplasty (TKA). Advanced bearings are therefore required in TKA to reduce or eliminate wear-related loosening. A recently introduced bearing that combines oxidized zirconium with highly cross-linked PE has been shown to drastically reduce wear in in vitro settings, due to its improved tribological characteristics in both tibial and femoral components. However, there are no data on its cost-effectiveness.

Data and Methods: A Markov model was developed to assess the cost-effectiveness of this low-wear bearing from a German societal perspective. The model population was derived from a registry of 75,000 patients requiring TKA. The model allocated patients to receive either a low-wear or standard articulation, and followed them until death. Revisions and re-revision were included. Input values were derived from registry databases or from published reports in the literature. Threshold analysis and probabilistic sensitivity analysis were conducted to estimate model robustness.

Results: The low-wear articulation prevented 24 (2.4 percent) revisions and 8 (0.8 percent) re-revisions. The total incremental cost-effectiveness ratio (ICER) of the low-wear articulation was EUR 16,474 per quality-adjusted life-year (QALY). For patients aged less than 55 years, an ICER of EUR 653 per QALY was observed. For patients aged over 75 years, this value was EUR 83,300. Threshold and probabilistic sensitivity analysis indicated that these findings were reasonably robust.

Conclusion: Low-wear articulations may be considered cost-effective, although the cost effectiveness is age-dependent, with the cost per QALY being significantly lower for younger people than for older people.

Keywords

Total knee arthroplastyAdvanced bearingsCost-effectivenessMarkov modeling
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 2 , April 2014 , pp. 218 - 225
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

1. Saleh, KJ, Rand, JA, McQueen, DA. Current status of revision total knee arthroplasty: How do we assess results? J Bone Joint Surg Am. 2003;85(Suppl 1):S18–20.Google Scholar
2. Collier, JP, Mayor, MB, McNamara, JL, Surprenant, VA, Jensen, RE. Analysis of the failure of 122 polyethylene inserts from uncemented tibial knee components. 1991;:232–242.Google Scholar
3. Healy, WL, Finn, D. The hospital cost and the cost of the implant for total knee arthroplasty. A comparison between 1983 and 1991 for one hospital. J Bone Joint Surg Am. 1994;76:801–806.CrossRefGoogle ScholarPubMed
4. Lavernia, CJ, Guzman, JF, Gachupin-Garcia, A. Cost effectiveness and quality of life in knee arthroplasty. Clin Orthop Relat Res. 1997;:134–139.Google Scholar
5. Heyse, TJ, Haas, SB, Efe, T. The use of oxidized zirconium alloy in knee arthroplasty. Expert Rev Med Devices. 2012;9:409–421.Google Scholar
6. Ezzet, KA, Hermida, JC, Steklov, N, D'Lima, DD. Wear of polyethylene against oxidized zirconium femoral components effect of aggressive kinematic conditions and malalignment in total knee arthroplasty. J Arthroplasty. 2012;27:116–121.CrossRefGoogle ScholarPubMed
7. Ries, MD, Salehi, A, Widding, K, Hunter, G. Polyethylene wear performance of oxidized zirconium and cobalt-chromium knee components under abrasive conditions. J Bone Joint Surg Am. 2002;84(Suppl 2):129–135.Google Scholar
8. Hodrick, JT, Severson, EP, McAlister, DS, Dahl, B, Hofmann, AA. Highly crosslinked polyethylene is safe for use in total knee arthroplasty. Clin Orthop Relat Res. 2008;466:2806–2812.Google Scholar
9. Minoda, Y, Aihara, M, Sakawa, A, et al. Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty. Knee. 2009;16:348–351.Google Scholar
10. Smith & Nephew Inc. VERILAST technology for knees. Global.smith-nephew.com/us/12146.htm (accessed November 2011).Google Scholar
11. Heck, DA, Robinson, RL, Partridge, CM, Lubitz, RM, Freund, DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;93–110.Google Scholar
12. Slover, J, Espehaug, B, Havelin, LI, et al. Cost-effectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients. A Markov decision analysis. J Bone Joint Surg Am. 2006;88:2348–2355.Google Scholar
13. Slover, JD, Rubash, HE, Malchau, H, Bosco, JA. Cost-effectiveness analysis of custom total knee cutting blocks. J Arthroplasty. 2012;27:180–185.Google Scholar
14. Knutson, K, Robertsson, O. The Swedish Knee Arthroplasty Register (http://www.knee.se). Acta Orthop. 2010;81:5–7.Google Scholar
15. Robertsson, O. Knee arthroplasty registers. J Bone Joint Surg Br. 2007;89:1–4.Google Scholar
16. Sheng, PY, Konttinen, L, Lehto, M, et al. Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2006;88:1425–1430.Google Scholar
17. Federal Statistical Office of Germany. Life table for Germany. www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/EN/Navigation/Statistics/Bevoelkung/GeburtenSterbefaelle/Tabellen.psml (accessed August 2010).Google Scholar
18. Sharkey, PF, Hozack, WJ, Rothman, RH, Shastri, S, Jacoby, SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;7–13.Google Scholar
19. Fehring, TK, Odum, S, Griffin, WL, Mason, JB, Nadaud, M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001;315–318.Google Scholar
20. Gioe, TJ, Killeen, KK, Grimm, K, Mehle, S, Scheltema, K. Why are total knee replacements revised?: Analysis of early revision in a community knee implant registry. Clin Orthop Relat Res. 2004;100–106.Google Scholar
21. Berend, ME, Ritter, MA, Meding, JB, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;26–34.Google Scholar
22. Bozic, KJ, Kurtz, SM, Lau, E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.CrossRefGoogle ScholarPubMed
23. Ghomrawi, HM, Kane, RL, Eberly, LE, et al. Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am. 2009;91:2838–2845.Google Scholar
24. Mulhall, KJ, Ghomrawi, HM, Scully, S, Callaghan, JJ, Saleh, KJ. Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:45–50.Google Scholar
25. Deeks, J, Altman, D, Bradburn, M. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger, M, Davey Smith, G, Altman, D, eds. Systematic reviews in health care: Meta-analysis in context, 2nd edition. London: BMJ; 2001.Google Scholar
26. OECD. (2010). OECD factbook 2010. Economic, environmental and social statistics. Paris: OECD Publishing; 2011.Google Scholar
27. Magazin Deutschland. Germany ranks seventh in Europen labor costs comparison for 2010. www.magazin-deutschland.de/en/article/article/deutschland-liegt-bei-arbeitskosten-im-europaeischen-mittelfeld.html (accessed December 2011).Google Scholar
28. Brugiavini, A, Croda, E, Mariuzzo, F. Labour force participation in the elderly: Unused capacity? In: Börsch-Supan, A, Brugiavini, A, Jürges, H, et al., eds. Health, ageing and retirement in Europe. first results from the survey of health, ageing and retirement in Europe. Mannheim: Mannheim Research Institute for the Economics of Aging (MEA); 2005.Google Scholar
29. March, LM, Cross, M, Tribe, KL, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage. 2004;12:400–408.Google Scholar
30. Heiner, DE, Mauerhan, DR, Masonis, JL, Heath, J. Patient out-of-pocket expenses in major orthopedic procedures: Total hip arthroplasty as a case study. J Arthroplasty. 2008;23:509–514.Google Scholar
31. Gill, GS, Mills, D, Joshi, AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003;85:432–435.Google Scholar
32. Mahomed, NN, Barrett, J, Katz, JN, et al. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87:1222–1228.Google Scholar
33. Smith, DH, Gravelle, H. The practice of discounting in economic evaluations of healthcare interventions. Int J Technol Assess Health Care. 2001;17:236–243.Google Scholar
34. Fennema, P, Lubsen, J. Survival analysis in total joint replacement: An alternative method of accounting for the presence of competing risk. J Bone Joint Surg Br. 2010;92:701–706.CrossRefGoogle ScholarPubMed
35. Robertsson, O, Bizjajeva, S, Fenstad, AM, et al. Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop. 2010;81:82–89.CrossRefGoogle ScholarPubMed
36. Kim, YH, Kim, JS, Huh, W, Lee, KH. Weight of polyethylene wear particles is similar in TKAs with oxidized zirconium and cobalt-chrome prostheses. Clin Orthop Relat Res. 2010;468:1296–1304.Google Scholar
37. Iwakiri, K, Minoda, Y, Kobayashi, A, et al. In vivo comparison of wear particles between highly crosslinked polyethylene and conventional polyethylene in the same design of total knee arthroplasties. J Biomed Mater Res B Appl Biomater. 2009;91:799–804.Google Scholar
38. Margevicius, KJ, Bauer, TW, McMahon, JT, Brown, SA, Merritt, K. Isolation and characterization of debris in membranes around total joint prostheses. J Bone Joint Surg Am. 1994;76:1664–1675.CrossRefGoogle ScholarPubMed
39. Zhu, YH, Chiu, KY, Tang, WM. Review article: Polyethylene wear and osteolysis in total hip arthroplasty. J Orthop Surg (Hong Kong). 2001;9:91–99.CrossRefGoogle ScholarPubMed
40. Kurtz, SM, Gawel, HA, Patel, JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469:2262–2277.Google Scholar
41. Baker, DA, Bellare, A, Pruitt, L. The effects of degree of crosslinking on the fatigue crack initiation and propagation resistance of orthopedic-grade polyethylene. J Biomed Mater Res A. 2003;66:146–154.Google Scholar
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